Or. Admin. Code § 436-045-0030 - Reimbursement
(1) Reimbursement
shall be made by Compliance quarterly after receipt and approval of
documentation of compensation paid by the paying agent.
(2) The director, by bulletin, shall
prescribe the form and format for requesting reimbursement from the Program.
Documentation to support the reimbursement request shall include but not be
limited to:
(a) Net temporary disability
compensation paid, net permanent disability paid, and net medical compensation
paid for dates of injury prior to January 1, 1966. For purposes of this
section, "net" compensation paid means the total compensation paid less any
recoveries, including but not limited to, third party recovery, Retroactive
Program reimbursement, and Workers with Disabilities Program
reimbursement.
(b) Payment
certification statement.
(c) Any
other information deemed necessary by the director.
(3) Periodically Compliance shall audit the
physical file of the paying agent to validate the amount reimbursed and to
verify that the closing report is correct. Reimbursement shall not be approved
if, upon such audit, it is found:
(a)
Payments were not authorized in the Board's Own Motion order or voluntary claim
reopening; or
(b) Payments of
temporary disability compensation were made for periods of time during which
the worker did not qualify as a "worker" pursuant to ORS
656.005(28);
or
(c) Compensation has been paid
as a result of untimely, inaccurate, or improper claims processing;
or
(d) The separate payments of
compensation have not been documented, as required under generally accepted
accounting procedures; or
(e)
Medical payments for claims with injury dates prior to January 1, 1966 are in
excess of what should have been paid if paid in accordance with OAR
436-009-0030 and properly
audited as required by OAR
436-009-0020; or
(f) Permanent disability payments were made
in claims reopened for other than a new medical or omitted condition.
Notes
Statutory/Other Authority: ORS 656.625
Statutes/Other Implemented: ORS 656.625
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